Indian pediatrics最新文献

{"title":"H-ER-O-S: A Quality Improvement Initiative to Reduce Ventilator-Associated Pneumonia in a Level IIIb Neonatal Intensive Care Unit of a Tertiary Care Public Hospital.","authors":"Shaik Mohammed Munthakheem, Amol Kalyanrao Joshi, Laxmikant Sheshrao Deshmukh, Atul C Londhe","doi":"10.1007/s13312-025-00183-6","DOIUrl":"https://doi.org/10.1007/s13312-025-00183-6","url":null,"abstract":"<p><strong>Objective: </strong>To reduce the ventilator-associated pneumonia (VAP) rate by improving the compliance of components of the VAP prevention bundle to > 90% over a period of 35 weeks.</p><p><strong>Methods: </strong>This quality improvement study was conducted in the neonatal intensive care unit (NICU) of a tertiary care public hospital from May 2023 to March 2025. Baseline VAP rate was determined, and a team of all the stakeholders was formed. The problem was analyzed using various tools, and the main contributing factors for poor compliance with VAP bundle care were identified with the corresponding solution framed using the mnemonic H-ER-O-S: hand hygiene/head-end elevation, education/extubation readiness, oral care, suction care. Multiple plan-do-study-act (PDSA) cycles were done using point-of-care quality improvement (POCQI) methodology. The data were collected prospectively and analyzed regularly with the team members, and actions were planned accordingly.</p><p><strong>Results: </strong>The VAP rate (per 1000 ventilator days) decreased significantly from 49.5 at baseline (May 2023) to 32.51 (95% CI 18.66-46.37) in the intervention phase and sustained at 6.40 (95% CI 4.58-8.93) for a consecutive 14 months (February 2024 till March 2025). The baseline compliance for components of VAP care bundle increased from 57.9% (95% CI 54.5-61.2) to 88.3% (95% CI 86.9-89.7) and was sustained for 14 months at 94.0% (95% CI 93.3-94.8, P < 0.001).</p><p><strong>Conclusion: </strong>POCQI principles targeting the H-ER-O-S protocol help reduce VAP rates by increasing the compliance with the VAP care bundle.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implications of Spacer Contamination: Authors' Reply.","authors":"Kalyana Prabhakaran, Jagdish Prasad Goyal","doi":"10.1007/s13312-025-00185-4","DOIUrl":"https://doi.org/10.1007/s13312-025-00185-4","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Rare Cause of Pancytopenia in a Young Child: Infantile-Onset Multisystem Autoimmune Disease Type 1.","authors":"Tuphan Kanti Dolai, Kaustav Ghosh","doi":"10.1007/s13312-025-00191-6","DOIUrl":"https://doi.org/10.1007/s13312-025-00191-6","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Implications of Spacer Contamination.","authors":"Pulkit Agarwal","doi":"10.1007/s13312-025-00186-3","DOIUrl":"10.1007/s13312-025-00186-3","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors Influencing Cyclosporine Trough and Two-Hour Post-dose Concentrations in Children with Idiopathic Nephrotic Syndrome.","authors":"Priyatharsini Vellingiri, Sriram Krishnamurthy, Rajan Sundaram, Suganthi S Ramachandran","doi":"10.1007/s13312-025-00177-4","DOIUrl":"https://doi.org/10.1007/s13312-025-00177-4","url":null,"abstract":"<p><strong>Objective: </strong>To determine the cyclosporine trough (C₀) and two-hour post-dose concentrations (C₂) in children with nephrotic syndrome (NS) and study the factors influencing them.</p><p><strong>Methods: </strong>In this ambispective cohort study, children with NS (including frequently relapsing, steroid-dependent and steroid-resistant nephrotic syndrome) on cyclosporine therapy were enrolled. Clinical and laboratory data were recorded. C₀ and C₂ were estimated using liquid chromatography mass spectrometry.</p><p><strong>Results: </strong>Among 27 patients with a mean (SD) age of 6.4 (4.1) years, the median (Q1, Q3) of C₀ and C₂ were 114.8 (86.1, 186.3) ng/mL and 661.6 (442.1, 884.6) ng/mL, respectively. At a mean (SD) cyclosporine dose of 4.1 (0.8) mg/kg/day, 12 (44%) patients had C₀ above and 4 (15%) below the therapeutic range (80-120 ng/mL). C₂ levels were outside the recommended ranges in 17 (63%) children, within range in 7 (26%), and below in 3 (11%). Capsule users had higher C₀ than syrup users. Amlodipine therapy was associated with higher C₀ levels.</p><p><strong>Conclusion: </strong>Nearly half the children had C₀ and C₂ levels outside the therapeutic range. Dosage form and amlodipine influenced C₀, not C₂ concentrations.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015021","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Screening for Hemoglobinopathies: An Inceptive Experience of Centre of Excellence for Sickle Cell Disease.","authors":"Anita Vishnoi, Ritvika Jyani, Ayushi Sharma, Lakhan Poswal, Shuchi Goyal, Shelesh Kumar Swami, Nitesh Kumar Chauhan","doi":"10.1007/s13312-025-00178-3","DOIUrl":"https://doi.org/10.1007/s13312-025-00178-3","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the prevalence of various hemoglobinopathies among newborns, women in antenatal clinic and children presenting with signs and symptoms suggestive of sickle cell disease (SCD).</p><p><strong>Methods: </strong>A hospital-based prospective study was conducted at a Centre of Excellence for SCD (COESCD). Dried blood spot (DBS) samples were collected for newborn screening using heel-prick and venous samples were used in the post-neonatal age group. Hemoglobin variant analysis was performed using high-performance liquid chromatography (HPLC).</p><p><strong>Results: </strong>Out of 26,642 neonates screened, 1.87% (n = 498) were found to have abnormal hemoglobin patterns. The prevalence of hemoglobin variants detected among women screened during antenatal check-up and children with signs and symptoms of SCD were found to be 6.11% and 22.69%, respectively.</p><p><strong>Conclusion: </strong>Intensive screening programs have led to detection of a large number of cases with hemoglobinopathies including rare hemoglobin variants.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Congenital Glucose-Galactose Malabsorption: A Rare Cause of Intractable Diarrhea in Infancy.","authors":"Ashwinee Rath, Samir Sethi, Biswajit Pattanaik","doi":"10.1007/s13312-025-00187-2","DOIUrl":"https://doi.org/10.1007/s13312-025-00187-2","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145015030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurse-Led Quality Improvement Initiative to Reduce Medication Errors in Pediatric ICU.","authors":"Shivani Kumari, Arun Bansal, Meenakshi Agnihotri, Ruchi Saini","doi":"10.1007/s13312-025-00180-9","DOIUrl":"https://doi.org/10.1007/s13312-025-00180-9","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effectiveness of a context-specific, nurse-driven medication errors bundle in reducing the incidence of medication errors (MEs) by ≥ 50% in a pediatric intensive care unit (PICU).</p><p><strong>Methods: </strong>We conducted a prospective, before-and-after quality improvement study, between February and November 2023, in a 15-bedded multidisciplinary PICU of a tertiary public hospital in northern India. Prescriptions advised to children hospitalized during the study period were analyzed. The intervention comprised of a structured prescription format, nursing observation and administration charts, and drug incompatibility charts. The bundle was implemented through four sequential Plan-Do-Study-Act (PDSA) cycles. Medication errors were categorized into prescription, dispensing, administration, and monitoring errors and assessed for severity using the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) Index. The primary outcome was change in the overall ME rate. The secondary outcomes included category-specific error rates and improvement in staff awareness of quality improvement principles.</p><p><strong>Results: </strong>A total of 968 prescriptions were evaluated during the pre-assessment phase and 1,386 during the intervention. The overall ME rate declined from 8.5% to 2.9%, prescription errors dropped from 13.1% to 3.8%, dispensing errors from 12.2% to 5.2%, administration errors from 3.8% to 1.9%, and monitoring errors from 1.7% to 0%. Most errors were intercepted and corrected before reaching the patient (NCC MERP Category B). Quality improvement awareness among staff improved from 55.5% to 84%.</p><p><strong>Conclusion: </strong>A low-cost, nurse-led, multidisciplinary medication errors bundle led to a sustained reduction in MEs, demonstrating its potential for use in comparable PICU settings.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145000395","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stakeholder's Perspectives on the Barriers and Facilitators of Childhood Cancer Care in India.","authors":"Anita Nath, Prashant Mathur, Kondalli Lakshminarayana Sudarshan, Ramandeep Arora, Rachna Seth, Sanjiv Kumar, Girish Chinnaswamy, Atul Budukh, Varinder Singh, T Priya Kumari, Raja Paramjeet Singh Banipal, Vijay Kumar Bodal, A R Arun Kumar, C R Vijay, T Avinash, C Ramesh, Sadashivudu Gundeti, Shikha Malik, Narendra Kumar Chaudhary, Gautam Majumdar, Deepshikha Das, Nita Radhakrishnan, V Surya Rao, Manoj Rawal, Jeremy L Pautu, Deepak Sundriyal, Munlima Hazarika, Caleb Harris, Sunil Natha Jondhale, Vinotsole Khamo, Arshad Manzoor Najmi, Puneet Pareek, Ratan Konjengbam, Saroj Kumar Das Majumdar, Shashank Pandya, Anand Shah, S B Singh, Venkatraman Radhakrishnan, R Swaminathan, Chandra Mohan Kumar, Pritanjali Singh, Lokesh Tiwari, Syamsundar Mandal, Sopai Tawsik, Awadhesh Kumar Pandey, K Gunaseelan, Tseten W Bhutia","doi":"10.1007/s13312-025-00098-2","DOIUrl":"10.1007/s13312-025-00098-2","url":null,"abstract":"<p><strong>Objective: </strong>To explore the stakeholders' perspectives on barriers and facilitators influencing childhood cancer care delivery in India.</p><p><strong>Methods: </strong>A nationwide survey was conducted across 26 states and 4 Union Territories, involving childhood cancer physicians from tertiary and secondary hospitals, state nodal officers (SNOs) for the National Programme for Control of Non-Communicable Diseases (NP-NCD), and representatives from Civil Society Organizations (CSOs) and Non-Governmental Organizations (NGOs). A hub-and-spoke sampling model was employed, with designated tertiary hospitals coordinating data collection from secondary hospitals. An online survey tool assessed perceived challenges and facilitators in childhood cancer care. Data collection occurred from July to September 2021, and descriptive statistics were used for analysis.</p><p><strong>Results: </strong>Responses were received from 137 tertiary hospitals (100%), 92 secondary hospitals (91%), 16 SNOs (53.3%), and 9 CSO/NGO representatives (23.1%). Key barriers to diagnosis and treatment included shortage of human resources, beds, and equipment, along with advanced-stage presentation and inadequate back-referrals from tertiary to secondary hospitals. Treatment abandonment and denial were highlighted as major concerns. SNOs and CSOs identified financial constraints, limited insurance coverage, and reliance on traditional healers as additional challenges. Facilitators included strengthening referral networks, expanding diagnostic capabilities, ensuring free treatment and medications, and improving infrastructure and workforce capacity.</p><p><strong>Conclusion: </strong>Resource constraints, late-stage presentation, treatment abandonment, and financial challenges are the significant barriers to childhood cancer care in India. Addressing these through improved referral systems, expanded diagnostic services, financial support mechanisms, and policy-level interventions are needed to enhance childhood cancer care outcomes and quality of life.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"662-670"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144198962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum: Normal Values of Acid Steatocrit in Indian Children: A Prospective Analytical Study.","authors":"Pankaj Kumar, Vyom Aggarwal","doi":"10.1007/s13312-025-00164-9","DOIUrl":"10.1007/s13312-025-00164-9","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"714"},"PeriodicalIF":1.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}